Catalogue no.82-624‑X
ISSN 1925-6493
Health at a Glance
Difficulty accessing
health care services in Canada
by Janine Clarke
Release date: December 8, 2016
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Health
at a Glance
Difficulty accessing health care services
in Canada
by Janine Clarke
Highlights
• In 2013, the majority of Canadians who needed health care (aged 15 years and older) did not report any
difficulty with access (71%).
• Of those who reported difficulties accessing services, “waiting too long for an appointment” and “difficulty
getting an appointment” were the most common problems reported.
• Canadians who reported fair or poor perceived health had the highest odds of reporting difficulty accessing
specialized services such as specialist care, non-emergency surgery and selected diagnostics tests.
• Those with higher levels of education (i.e., at least some post-secondary) had the highest odds of reporting
difficulty accessing first-contact services (e.g., immediate care, routine care or health information).
Introduction
Easy and timely access to health care services is important
for the health of Canadians. Difficulty accessing services
could result in: delays seeking and obtaining treatment,
underuse or a lack of awareness of preventive health care
or services, increased risk of complications if a diagnosis is
delayed, increased financial burden on the health care system
(e.g., if patients arrive sicker and/or need to stay longer in
hospital), and/or decreased compliance with treatment.1,2
As such, an important goal of Canada’s national health
insurance program is to ensure that all Canadians have
access to medically necessary services free of cost.3,4 However
there are other factors, such as wait times, that can affect
access to health care services resulting in some Canadians
experiencing difficulty getting the care that they need.2,5
This article explores Canadians’ (age 15 and older) selfreported experiences regarding access to selected health
care services, in the year prior to answering the survey.
Statistics Canada, Catalogue no. 82-624-X • Health at a Glance, December 2016
Difficulty accessing health care services in Canada
Definitions of the health care services
examined in this article6,7
Specialized services is the term that will be
used throughout this article to collectively refer
to the following 3 types of health care services:
• Specialist care is care from a medical specialist,
such as a cardiologist, allergist, urologist/
gynaecologist or psychiatrist, excluding an
optometrist, for a diagnosis or consultation.
• Non-emergency surgery is any scheduled
or planned non-emergency surgery, such as
cardiac surgery, joint surgery (e.g., knee or hip),
caesarean sections and cataract surgery, but
excluding laser eye surgery.
• Selected diagnostic tests are tests that include
magnetic resonance imaging (MRI) scans,
computerized tomography scans (CT scans),
and angiographies provided in non-emergency
situations.
First-contact services is the term that will be
used throughout this article to collectively refer
to the following 3 types of health care services:
• Immediate care is immediate care for a
minor health problem such as fever, headache,
sprained ankle, vomiting, minor burns, cuts,
skin irritation, unexplained rash or other health
problems or injuries due to a minor accident.
• Routine care is routine or on-going care
provided by a family doctor or general
practitioner for the respondent or the
respondent’s family member living in the same
dwelling. This includes an annual check-up,
blood tests, or routine care for an on-going
illness.
• Health information is information or advice
regarding a new or existing health condition
or disease. This could include information
over the telephone or directly from a health
care professional. Information may be about:
treatment, care or who to contact for care (e.g.,
doctor, emergency room, hospital clinic).
Data are from the “Access to health care services” module
which was asked to respondents in the 10 provinces as part
of the Canadian Community Health Survey every 2 years
from 2003 to 2013. The module asks specifically about two
groups of health care services: specialized services and firstcontact services.6,7,8 Specialized services include specialist
care, non-emergency surgery and selected diagnostic tests.
First-contact services include immediate care, routine
care and health information. The results presented in this
article are based on the population who required health care
services in the twelve months prior to answering the survey.
The percentage of Canadians who reported one or more
perceived difficulties accessing each of these health care
services, along with the most commonly reported reasons for
their difficulty, will be presented. In addition, we assessed
the sociodemographic (e.g., level of education, employment
status) and health characteristics (e.g., perceived health) of
those respondents who reported difficulty accessing health
care services. The characteristics examined in this article were
previously found to be associated with difficulty accessing
immediate or routine care.2
Most Canadians did not report difficulty accessing
health care services
In 2013, about 80% of Canadians aged 15 and older accessed
one or more specialized or first-contact health care service
in the year prior to being surveyed. Of those, the majority
(71%) did not report any difficulty accessing services.
The remainder of this article, however, will focus on the
Canadians who reported difficulty getting the care they
needed. The percent of Canadians that reported difficulty
accessing various health care services varied depending
on the health care service. For example, 16% reported
difficulty accessing non-emergency surgery while 23%
reported difficulty accessing immediate care (Charts 1 and
2). For most types of health care services, the percentage
who reported difficulty accessing care has not changed
significantly since 2003. However, in 2013 the percentage
who reported difficulty accessing specialist care or selected
diagnostic tests was significantly lower compared to
2003 (Chart 1).
Statistics Canada, Catalogue no. 82-624-X • Health at a Glance, December 2016
4
Difficulty accessing health care services in Canada
Chart 1
Percentage reporting difficulty accessing specialized¹ health care services, Canadians aged 15 and older,² 2003 to 2013
percent
40
35
30
25
*
*
20
*
*
*
15
10
5
0
Specialist care
2003
†
Non-emergency surgery
2005
2007
Selected diagnostic tests
2009
2011
2013
* significantly different from reference group (p < 0.05)
reference group
1. See the "Definitions of the health care services examined in this article" text box for definitions of the variables in this chart.
2. Based on the population requiring health care services in the 12 months prior to answering the survey
Source: Statistics Canada, 2003, 2005, 2007, 2009, 2011 and 2013 Canadian Community Health Survey.
†
Chart 2
Percentage reporting difficulty accessing first-contact¹ health care services, Canadians aged 15 and older,² 2003 to 2013
percent
40
35
30
25
*
*
20
*
15
10
5
0
Health information or advice
2003†
Routine care
2005
2007
Immediate care
2009
2011
2013
* significantly different from reference group (p < 0.05)
†
reference group
1. See the "Definitions of the health care services examined in this article" text box for definitions of the variables in this chart.
2. Based on the population requiring health care services in the 12 months prior to answering the survey
Source: Statistics Canada, 2003, 2005, 2007, 2009, 2011 and 2013 Canadian Community Health Survey.
Statistics Canada, Catalogue no. 82-624-X • Health at a Glance, December 2016
Difficulty accessing health care services in Canada
5
Table 1
Three most commonly reported reasons for difficulties accessing health care services, by type of health care service,1 Canadians
aged 15 and older,2 2009 to 20133
Reasons for difficulty, by type of health care service
Percent (%)
95% confidence interval
Difficulty getting an appointment
43
(40 to 45)
Waited too long for an appointment
51
(49 to 53)
Waited too long to see a doctor (in-office waiting)
17
(15 to 19)
Difficulty getting an appointment with a surgeon
31
(27 to 36)
Waited too long for surgery
60
(55 to 65)
Still waiting for surgery
14
(11 to 18)
Difficulty getting an appointment
26
(22 to 30)
Waited too long for an appointment
53
(49 to 57)
Waited too long to see a doctor (in-office waiting)
22
(19 to 25)
Difficulty contacting a nurse or physician
40
(38 to 43)
Waited too long to speak to someone
36
(34 to 39)
Did not get adequate information or advice
29
(27 to 31)
Difficulty contacting a physician
23
(21 to 25)
Difficulty getting an appointment
48
(46 to 50)
Waited too long to get an appointment
38
(36 to 40)
Difficulty getting an appointment
31
(29 to 34)
Waited too long to get an appointment
26
(24 to 29)
Waited too long to see a doctor (in-office waiting)
49
(46 to 52)
Specialized services
Specialist care
Non-emergency surgery
Selected diagnostic tests
First-contact services
Health information or advice
Routine or on-going care
Immediate care (minor health problem)
1. See the “Definitions of the health care services examined in this article” text box for definitions of the variables in this table.
2. Based on the population reporting difficulties accessing these services in the 12 months prior to answering the survey. For first contact services, this includes accessing services for
self or for a family member living in the same dwelling.
Note: When asked about the type of difficulty experienced, respondents were able to select as many as were applicable. As such, the estimates do not add to 100%.
Source: Statistics Canada, 2009, 2011 and 2013 Canadian Community Health Survey.
“Waiting too long” was the most common reason
why Canadians reported difficulty accessing health
care services
People who reported difficulty accessing health care services
were asked a follow-up question regarding the reason(s) for
their difficulty.9 Although many different types of difficulties
were reported (e.g., language problems, cost, transportation
problems) the top 3 difficulties for each health care service
were included (Table 1). This was done in order to limit
the focus to the most important reasons. Furthermore, some
of the difficulties could not be presented due to a small
sample size.
Reasons related to “waiting too long” were among the top
three reasons for difficulties with accessing each type of
health care service (Table 1). More than 50% of those who
reported difficulty accessing any specialized services indicated
that the problem was with wait times for an appointment.
Wait times were also the main difficulty with access to
non‑emergency surgery, where 60% reported that they
waited too long for surgery. The percentage of Canadians
who reported waiting too long for non-emergency surgery
has remained unchanged over time (data not shown).
Statistics Canada, Catalogue no. 82-624-X • Health at a Glance, December 2016
6
Difficulty accessing health care services in Canada
Wait times for health care services is an important issue
in Canada – in 2004, the First Ministers committed to a
10‑year plan to reduce wait times in Canada for a number of
services/procedures.4 Although the current analysis indicates
that a significant percentage of Canadians reported “waiting
too long” as a barrier to accessing health care services, other
recent reports suggest that wait times for certain procedures
have improved in Canada since 2004.10 In fact, the majority
of Canadians are receiving procedures, such as hip or knee
replacement, hip fracture repair, cataract surgery, or radiation
therapy, in a “medically acceptable timeframe”, which is
defined as the amount of time that is appropriate to wait
for a procedure based on clinical evidence.11 However, what
is considered a “medically acceptable timeframe” may not
be considered an acceptable wait time from the perspective
of the patient. Since the questionnaire did not specifically
ask how long respondents had waited, it is not possible
to determine if the wait time was outside the medically
acceptable timeframe.
“Difficulty getting an appointment” was another reason
why many Canadians experienced difficulty accessing both
specialized and first-contact health care services (Table 1).
This reason was given most frequently (48%) by people
who had difficulty accessing routine care from a family
doctor or general practitioner. Having difficulty getting an
appointment could be related to physician availability in
Canada. The number of physicians in Canada is continually
increasing and in 2014 the physician-to‑population ratio
reached its highest ever (224 physicians per 100,000
people).12 However, in that same year, about 15% of
Canadians reported that they did not have a regular medical
doctor.13 This discrepancy may be due to the fact that of
those 224 physicians per 100,000 people, only 51% are
family doctors.12
For those who have a family doctor, difficulty getting
appointments could be related to how services are organized
or delivered by their healthcare provider. The amount of
time a physician spends on direct patient care in an average
week has decreased since the late 1990’s.14 However, in the
last decade, efforts have been made to improve access to
health care through the availability of group practices and
primary health care networks.15,16 Although, this model
of health care delivery is not yet fully implemented in all
provinces.15,16
Several factors are related to difficulty accessing
health care services
Multiple logistic regression analysis was used to identify
which of selected sociodemographic and health
characteristics were associated with difficulty accessing
specialized or first-contact health care services. The adjusted
odds ratio for each characteristic found to be significantly
associated with difficulty accessing health care services is
presented in Table 2. It represents the odds of experiencing
difficulty accessing health care services by a given
characteristic (e.g., female) compared to a reference group
(e.g., male), when the other characteristics were considered.
Age, sex, level of education, immigration status, region of
residence and perceived health were significantly associated
with difficulty accessing specialized services (Table 2).
The odds of reporting difficulty were significantly higher
compared with the reference group among: those under the
age of 65, females, immigrants, those with at least some
post-secondary education and those who reported poor
or fair perceived health. The odds of reporting difficulty
accessing specialized services were also significantly higher
for people living in Quebec or the western provinces (the
Prairies and British Columbia) compared with Ontario.
The results for first-contact services were similar to those for
specialized services, such that age, sex, level of education,
region of residence and perceived health were significantly
associated with difficulty accessing services (Table 2).
However, people without a regular medical doctor and
those who identified as Aboriginal (living off-reserve)
also had significantly higher odds of reporting difficulty
accessing first-contact services. By contrast, those living in
British Columbia (as compared with Ontario) and those
with either part-time or no employment (as compared with
full-time employment) had a significantly lower odds of
difficulty accessing first-contact services. These results are
consistent with previous research in Canada, however the
strength of the association is generally lower (i.e., all odds
ratios are less than 2) in the present analysis which suggests
that there may have been some improvement over time.2,17
There are many inter-related factors that may affect one’s
ability to access health care services, including personal
factors (e.g., work schedule, family responsibilities) and
system factors (e.g., availability of services). Together these
Statistics Canada, Catalogue no. 82-624-X • Health at a Glance, December 2016
Difficulty accessing health care services in Canada
7
Table 2
Adjusted odds ratios of difficulties accessing health care services,1 by selected characteristics, Canadians aged 15 and older,2
2009 to 20133
Specialized services
Characteristics
Adjusted
odds ratio
First-contact services
95%
confidence
interval
Adjusted
odds ratio
95%
confidence
interval
Age group
15 to 64
1.51* (1.33 to 1.71)
1.67* (1.50 to 1.85)
65 or older†
1.00
…
1.00
…
Male†
1.00
…
1.00
…
Female
1.12* (1.01 to 1.23)
1.36* (1.27 to 1.45)
Less than high school†
1.00
…
1.00
…
High school
1.13
(0.91 to 1.41)
1.18
(1.00 to 1.39)
Some post-secondary or higher
1.40* (1.16 to 1.68)
1.75* (1.51 to 2.02)
Currently working - full time†
1.00
…
1.00
Currently working - part time
0.85
(0.72 to 1.01)
0.82* (0.73 to 0.91)
Not working4
0.90
(0.80 to 1.01)
0.84* (0.77 to 0.91)
Immigrant
1.15*
(1.01 to 1.3)
1.08
(0.98 to 1.20)
Canadian-born†
1.00
…
1.00
…
Yes
0.88
(0.70 to 1.1)
No†
1.00
…
1.00
…
1.06
(0.93 to 1.21)
0.98
(0.89 to 1.08)
Sex
Level of education
Employment status
…
Immigration status
Aboriginal identity
1.26* (1.07 to 1.47)
Region
Atlantic
Quebec
1.36* (1.18 to 1.56)
1.53* (1.39 to 1.69)
Ontario†
1.00
1.00
Prairies
1.17* (1.03 to 1.34)
1.18* (1.07 to 1.31)
British Columbia
1.36* (1.17 to 1.57)
0.87* (0.76 to 0.99)
…
…
Perceived health
Poor or fair
1.83* (1.62 to 2.05)
1.64* (1.49 to 1.80)
Good, very good or excellent†
1.00
…
1.00
…
Yes†
1.00
…
1.00
…
No
1.14
(0.97 to 1.34)
Has a regular medical doctor
1.43* (1.28 to 1.59)
… not applicable
* significantly different from reference group (p < 0.05)
†
reference group
1. See the “Definitions of the health care services examined in this article” text box for definitions of the variables in this table.
2. Based on the population reporting difficulties accessing these services in the 12 months prior to answering the survey. For first contact services, this includes accessing services for self
or for a family member living in the same dwelling.
3. Results are based on the combined data from the 2009, 2011 and 2013 Canadian Community Health Survey.
4. Includes those aged 15 to 75 who are currently not working and those aged 76 and older who are not asked any questions on employment.
Note: All variables were included in the logistic regression model at the same time. Results are also adjusted for survey year to account for possible changes over time. Income and
residence type (population centre or rural area) were also included in the model but are not displayed due to a lack of statistical significance. For more information on logistic regression,
see the section on “Data source, methods and definitions”.
Source: Statistics Canada, combined 2009, 2011 and 2013 Canadian Community Health Survey.
Statistics Canada, Catalogue no. 82-624-X • Health at a Glance, December 2016
8
Difficulty accessing health care services in Canada
have a complex effect on an individual’s opinion about
their access to health care which is important to consider
when interpreting the results of this study. For many of
the characteristics examined in this article, the higher
odds of difficulty accessing health care may be related to a
greater need for health care services. That is, there may be
greater opportunity to experience difficulty because of more
frequent use of health care services. For example, previous
research in Canada and the United States has shown that
women access health care services more than men.17,18,19 In
the present study, women had a higher odds of reporting
difficulties accessing care than men. However, we could not
assess whether difficulty accessing care was related to the
number of times a person accessed services due to limitations
of the questionnaire.
By contrast, some of the groups that had higher odds of
difficulty accessing care (e.g., those with higher education)
were less likely to have reported accessing health care in
the year prior to the survey (data not shown). One possible
explanation for this could be related to different expectations
among different groups. For example, it has been suggested
that those who are younger and those who are more
educated may have higher expectations or be more critical
of their experience.20,21,22 As such, younger or more educated
individuals may report more difficulty than their older or
less educated counterparts.
Factors related to a person’s availability is another possible
explanation for experiencing difficulty accessing care. For
example, those who work part-time or who do not work
may experience less difficulty getting appointments because
of a more flexible schedule compared with those who work
full-time.23
Income was also included in the analysis although the results
are not presented in Table 2 because the association with
difficulty accessing health care services was not significant.
This is consistent with previous research showing that
Canada’s universal health care coverage does help to reduce
income-based inequalities often associated with difficulty
accessing health care services.2,18,24
Conclusion
The results of this study show that on average about 29%
of Canadians who required health care reported difficulty
accessing these services. Wait times and difficulty getting
appointments were the most commonly reported reasons
for experiencing difficulty.
The results also showed that certain groups had higher
odds of reporting difficulty accessing health care services.
These included Canadians under the age of 65, females,
those with higher levels of education, full-time workers,
immigrants and those with poor or fair perceived health.
Further research to understand why these groups are having
difficulties is warranted.
Janine Clarke is an analyst with the Health Statistics
Division at Statistics Canada.
Statistics Canada, Catalogue no. 82-624-X • Health at a Glance, December 2016
Difficulty accessing health care services in Canada
9
Data source, methods and definitions
Data source
The Canadian Community Health Survey (CCHS) is a crosssectional survey that includes self-reported responses related to
health status, health care utilization and health determinants. The
CCHS includes Canadians aged 12 years and over who live in the
ten provinces and three territories. Persons living on reserves and
other Aboriginal settlements in the provinces; full-time members
of the Canadian Forces; the institutionalized population and
persons living in the Quebec health regions of Région du
Nunavik and Région des Terres-Cries-de-la-Baie-James were
not included in the survey. Altogether, these exclusions represent
less than 3% of the target population.
The Health Services Access module was asked to a subsample of
respondents from the CCHS every two years (2003, 2005, 2007,
2009, 2011 and 2013) to gather additional information on health
services and access to health care. The questions were asked to
Canadians 15 years and older who lived in the ten provinces.
Methods
Weighted frequencies and cross-tabulations were used to estimate
the percentage of people reporting difficulty when accessing
health care services.
Weighted frequencies and cross-tabulations were also used to
estimate the top three reasons for experiencing difficulty accessing
health care services. For this analysis, three years of data (2009,
2011 and 2013) were combined in order to increase the sample
size for the analysis. An increased sample size can help to reduce
the random variation that can occur with small numbers.
Multiple logistic regression analysis was used to evaluate the
association between the outcome variables (no difficulty versus
difficulty accessing either specialized or first-contact health care
services) and various sociodemographic and health characteristics,
simultaneously. The sociodemographic characteristics that were
examined were: age, sex, education, working status (not working,
employed part-time or employed full-time), income, region
of residence (Atlantic, Quebec, Ontario, Prairies or British
Columbia), type of area of residence (population centre or rural
area), immigrant status, Aboriginal identity (living off-reserve
only). The health characteristic examined was perceived health
(fair/poor versus good/very good/excellent). Whether or not the
respondent had a regular medical doctor was also explored. All
of these characteristics were included in the analysis at the same
time. This allowed for the examination of one characteristic at
a time by removing (i.e., holding constant or adjusting for) the
effects of the other characteristics.
The results of the logistic regression are presented as adjusted
odds ratios (Table 2). The value of an odds ratio can range from
zero to infinity. It is interpreted as a measure of the size of the
association between a given characteristic and the outcome (i.e.,
reporting difficulty accessing health care). The characteristics
examined in this article are all categorical, and so the odds ratios
are interpreted in comparison with a reference group within a
given characteristic. For example, if the characteristic of interest
is sex and the reference group is “males”, then an odds ratio less
than 1 means that the odds of the outcome occurring are lower
for females compared with males. An odds ratio greater than
1 means that the odds of the outcome occurring are higher for
females compared with males. An odds ratio equal to 1 means
that the non-reference group is not different from the reference
group (e.g. no difference between females and males reporting
difficulty accessing care).
Three years of data (2009, 2011 and 2013) were combined for the
regression analysis to increase the sample size. For all analyses,
bootstrap weights were used to take into account the complex
design of the survey.
Definitions
Aboriginal refers to those who self-identified as First Nations,
Métis or Inuk (Inuit) living off-reserve. Persons living on reserves
and other Aboriginal settlements are excluded from the survey’s
coverage.
Immigrants are those who reported that they were not a
Canadian citizen by birth, regardless of the length of time since
they first immigrated to Canada.
Perceived health is derived from the answer to the question
‘In general, would you say your health is: excellent, very good,
good, fair or poor?’ For the purpose of the analysis, those who
reported their health as “poor” or “fair” were grouped together
while those who reported their health as “good”, “very good” or
“excellent” were grouped together. Perceived health is used as an
indicator of overall health status.7
Population centre refers to an area with a minimum of 1,000
persons and a density of at least 400 persons per square kilometre,
based on the current census population count.25
Rural area refers to all areas lying outside of population
centres.25 Taken together, population centres and rural areas
cover all of Canada.25
Statistics Canada, Catalogue no. 82-624-X • Health at a Glance, December 2016
10
Difficulty accessing health care services in Canada
References and notes
1. Health Canada. 2013. Healthy Canadians 2012 – A Federal Report
on Comparable Health Indicators. Ottawa, Ontario (accessed July 7,
2016).
2. Sanmartin, C, and N. Ross. 2006. “Experiencing difficulties accessing
first-contact health services in Canada.” Healthcare Policy. Vol. 1,
no. 2, p. 103–119 (accessed July 7, 2016).
3. Health Canada. 2010. “Canada Health Act.” Health Care System
(accessed October 21, 2016).
4. Health Canada. 2004. A 10-year Plan to Strengthen Health Care.
Ottawa, Ontario : Health Canada (accessed July 7, 2016).
5. Statistics Canada. 2016. “Unmet health care needs, 2014.” Health
Fact Sheets. Statistics Canada catalogue no. 82-625-X (accessed
July 7, 2016).
6. Statistics Canada. 2002. Health Services Access Survey – User Guide.
Ottawa, Ontario (accessed July 7, 2016).
7. Statistics Canada. 2013. Canadian Community Health Survey
(CCHS) – Interviewer’s Manual (CAPI). Ottawa, Ontario.
8. For all specialized services, respondents were asked to think about
their own experiences accessing services. For all first-contact services,
respondents were asked to think about their experiences accessing
health care services for themselves or for a family member living in
the same household.
9. When asked about the type of difficulty experienced, respondents
were able to select as many as were applicable. As such, the estimates
do not add to 100%.
10. Canadian Institute for Health Information. 2016. Wait Times for
Priority Procedures in Canada, 2016. Ottawa, Ontario (accessed
July 7, 2016).
11. Ontario Ministry of Health and Long-Term Care. 2005. First Ever
Common Benchmarks Will Allow Canadians to Measure Progress in
Reducing Wait Times (media release). Toronto, Ontario: Ontario
Ministry of Health and Long-Term Care (accessed September 14,
2016).
12. Canadian Institute for Health Information. 2015. Physicians in
Canada, 2014. Ottawa, Ontario : CIHI (accessed July 7, 2016).
13. Statistics Canada. 2015. “Access to a regular medical doctor, 2014.”
Health Fact Sheets. Statistics Canada catalogue no. 82-625-X
(accessed July 7, 2016).
14. Canadian Medical Association. 2016. “Physician Data Centre:
Canadian physician statistics.” (accessed October 21, 2016).
15. Hutchison, B. 2013. “Reforming Canadian primary care – Don’t
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